POS0305 CONTINUING TNFI AFTER PREGNANCY DIAGNOSIS IN WOMEN WITH CHRONIC RHEUMATIC INFLAMMATORY DISEASES IS NOT ASSOCIATED WITH WORSE OBSTETRICAL OR INFECTIOUS OUTCOMES: THE RESULTS OF AN EMULATED TARGET TRIAL
Authors: A. Moltó, A. Ajrouche, D. Tran, Y. De-Rycke, N. Costedoat-Chalumeau, E. Elefant, V. Tsatsaris, J. Fresson, B. Bader-Meunier, B. Fautrel, F. Tubach
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Continuation of biologics during pregnancy in patients with chronic inflammatory diseases during pregnancy is still a difficult medical decision. Many women with chronic rheumatic inflammatory diseases (CRID) decide to stop tumor necrosis factor inhibitors (TNFi) treatment once pregnancy is confirmed to avoid potential adverse fetal events but taking the risk of inflammatory flare. <h3>Objectives</h3> To compare in real life settings the pregnancy outcomes of two treatment strategies among women with CRID: to continue TNFi vs. stop TNFi upon pregnancy diagnosis. <h3>Methods</h3> the French nationwide health insurance database (<i>Système National des Données de Santé</i>) was used to emulate a target trial in adult women, with CRID (i.e., rheumatoid arthritis, psoriatic arthritis or spondyloarthritis), having started a singleton pregnancy between 2008 and 2017, and and being treated with TNFi upon pregnancy diagnosis. We compared the frequency of unfavorable pregnancy outcomes (malformations, obstetrical complications, and infections) between the treatment strategies at pregnancy diagnosis, using inverse probability weighted marginal models. <h3>Results</h3> A total of 1466 pregnancies were included, and among them, TNFi treatment was discontinued after pregnancy diagnosis in 74%. Mean (SD) age of women at the start of pregnancy was 31 (5) years and mean (SD) disease duration was 4 (5) years. Continuation of TNFi was not associated with increased frequencies of unfavorable pregnancy outcomes: interestingly, the proportion of pregnancies with at least one unfavorable obstetrical outcome tended to be lower in the group of patients continuing the TNFi after pregnancy diagnosis but without reaching statistical significance: 66 (17.3%) vs. 201 (18.5%) in the group continuing vs. discontinuing, respectively (adjusted RR= 0.79 [95% CI, 0.57; 1.10]). Also, there was a trend for a lower frequency of severe maternal infections in the group continuing the TNFi (7 (1.8%) vs. 36 (3.3%), (aRR=0.43 [0.16; 1.14]). Table. <b>Limitation:</b> Algorithms rather than clinical data were used to identify patients with CRID, pregnancies, obstetrical outcomes, malformation and serious infections. <h3>Conclusion</h3> In pregnant women with CRID treated with TNFi until pregnancy diagnosis, neither unfavorable obstetrical outcomes nor severe infections were significantly increased in patients continuing TNFi during pregnancy, compared with a strategy of stopping TNFi. <h3>Reference</h3> [1]Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. <h3>Acknowledgements</h3> This study was conducted thanks to the French national grant PHRC 2019. <h3>Disclosure of Interests</h3> Anna Moltó Consultant of: Abbvie, Biogen, BMS, Gilead, Lilly, MSD, Novartis, Pfizer, UCB, Grant/research support from: Biogen UCB, Aya Ajrouche: None declared, Diep Tran: None declared, yann de-rycke: None declared, Nathalie Costedoat-Chalumeau: None declared, Elisabeth Elefant: None declared, Vassilis Tsatsaris: None declared, Jeanne Fresson: None declared, Brigitte Bader-Meunier: None declared, Bruno Fautrel: None declared, Florence Tubach: None declared.